S&C QCOR HHA 2567s
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HHAs 2567s
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Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific HHA deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 157211 Home Nursing Services Inc 528 W Washington Blvd Fort Wayne IN 5 (Chicago) 01/12/2021 K4OP12 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
G0510 Comprehensive Assessment of Patients Condition
G0544 Update of the comprehensive assessment Standard
G0942 Governing body Standard
G1024 Authentication Standard
G0546 Last 5 days of every 60 days unless: Element
G0610 Patients receive education and training Element
G0714 Patient and caregiver education Element
G0726 Nursing services supervised by RN Element
G0948 Responsible for all day-to-day operations Element
G0962 Coordinate patient care Element
G0966 Assure patient needs are continually assessed Element
G0968 Assure implementation of plan of care Element
▼ 157211 Home Nursing Services Inc 528 W Washington Blvd Fort Wayne IN 5 (Chicago) 08/27/2020 K4OP11 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0570 Care planning, coordination, quality of care Condition
G0940 Organization and administration of services Condition
E0019 Homebound HHA/Hospice Inform EP Officials Standard
E0039 EP Testing Requirements Standard
G0564 Discharge or Transfer Summary Content Standard
G0642 Program scope Standard
G0682 Infection Prevention Standard
G0684 Infection control Standard
G0798 Home health aide assignments and duties Standard
G0454 HHA can no longer meet the patient's needs Element
G0484 Document complaint and resolution Element
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0534 Patient's needs Element
G0536 A review of all current medications Element
G0538 Primary caregiver(s), if any Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0592 Revised plan of care Element
G0608 Coordinate care delivery Element
G0800 Services provided by HH aide Element
G0804 Aides are members of interdisciplinary team Element
G0972 Report all branch locations to SA Element
G0978 Must have a written agreement Element
G0980 Primary HHA is responsible for patient care Element
▼ 157211 Home Nursing Services Inc 528 W Washington Blvd Fort Wayne IN 5 (Chicago) 01/29/2019 53L011 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0684 Infection control Standard
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0708 Development and evaluation of plan of care Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0808 Onsite supervisory visit every 14 days Element
G1012 Required items in clinical record Element
▼ 157213 F C Of Indiana Inc 5250 East U S 36 Ste 1102 Avon IN 5 (Chicago) 03/23/2018 DKVP11 Complaint, Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0514 RN performs assessment Element
G0520 5 calendar days after start of care Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0588 Reviewed, revised by physician every 60 days Element
▼ 157214 Nurses And More, Inc 8925 N Meridian St Ste 105 Indianapolis IN 5 (Chicago) 11/14/2024 64A54-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
G0370 Reporting OASIS information Condition
G0570 Care planning, coordination, quality of care Condition
G0640 Quality assessment/performance improvement Condition
G0940 Organization and administration of services Condition
G0372 Encoding and transmitting OASIS Standard
G0572 Plan of care Standard
G0798 Home health aide assignments and duties Standard
G0942 Governing body Standard
G0414 HHA administrator contact information Element
G0574 Plan of care must include the following Element
G0580 Only as ordered by a physician Element
G0590 Promptly alert relevant physician of changes Element
G0616 Patient medication schedule/instructions Element
G0808 Onsite supervisory visit every 14 days Element
G0948 Responsible for all day-to-day operations Element
▼ 157214 Nurses And More, Inc 8925 N Meridian St Ste 105 Indianapolis IN 5 (Chicago) 08/12/2021 93TU11 Complaint, Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0024 Policies/Procedures-Volunteers and Staffing Standard
G0572 Plan of care Standard
G0852 Information to the state survey agency Standard
G0464 Advise the patient of discharge for cause Element
G0468 Provide contact info other services Element
G1022 Discharge and transfer summaries Element
▼ 157214 Nurses And More, Inc 8925 N Meridian St Ste 105 Indianapolis IN 5 (Chicago) 01/26/2018 NK5211 Complaint
Deficiency Tag Deficiency Description Tag Type
G0000 Initial Comments - Not a Deficiency Citation Memo
G0512 Standard: Initial assessment visit. Standard
G0572 Plan of care Standard
G1024 Authentication Standard
G0436 Receive all services in plan of care Element
G0484 Document complaint and resolution Element
G0536 A review of all current medications Element
G0574 Plan of care must include the following Element
G0710 Provide services in the plan of care Element
G0716 Preparing clinical notes Element
G0718 Communication with physicians Element
G0948 Responsible for all day-to-day operations Element
G0968 Assure implementation of plan of care Element
▼ 157217 Good Samaritan Home Care Services Of Vincennes In 328 N 2nd St, Suite 300 Vincennes IN 5 (Chicago) 02/24/2026 1E43CB-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0580 Only as ordered by a physician Element
G0948 Responsible for all day-to-day operations Element
▼ 157217 Good Samaritan Home Care Services Of Vincennes In 328 N 2nd St, Suite 300 Vincennes IN 5 (Chicago) 03/24/2023 5F434-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
G0682 Infection Prevention Standard
G0434 Participate in care Element
G0574 Plan of care must include the following Element
G0708 Development and evaluation of plan of care Element
G0716 Preparing clinical notes Element
G0948 Responsible for all day-to-day operations Element
▼ 157221 Amedisys Sp-In Llc 303 Quartermaster Ct Jeffersonville IN 5 (Chicago) 01/18/2023 5EA3C-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
G0000 Initial Comments - Not a Deficiency Citation Memo
E0039 EP Testing Requirements Standard
G0564 Discharge or Transfer Summary Content Standard
G0944 Administrator must: Standard
G1024 Authentication Standard
G0528 Health, psychosocial, functional, cognition Element
G0530 Strengths, goals, and care preferences Element
G0574 Plan of care must include the following Element
G0614 Visit schedule Element
G0616 Patient medication schedule/instructions Element
G0978 Must have a written agreement Element